内科住院医师参与为期5个月的门诊患者管理课程的经历。

Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum.

作者信息

Hadley Strout Emily K, Landrey Alison R, MacLean Charles D, Sobel Halle G

出版信息

J Grad Med Educ. 2018 Oct;10(5):559-565. doi: 10.4300/JGME-D-18-00172.1.

DOI:10.4300/JGME-D-18-00172.1

PMID:30386483

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6194901/

Abstract

BACKGROUND

Panel management is emphasized as a subcompetency in internal medicine graduate medical education. Despite its importance, there are few published curricula on population medicine in internal medicine residency programs.

OBJECTIVE

We explored resident experiences and clinical outcomes of a 5-month diabetes and obesity ambulatory panel management curriculum.

METHODS

From August through December 2016, internal medicine residents at the University of Vermont Medical Center reviewed registries of their patients with diabetes, prediabetes, and obesity; completed learning modules; coordinated patient outreach; and updated gaps in care. Resident worksheets, surveys, and reflections were analyzed using descriptive and thematic analyses. Before and after mean hemoglobin A1c results were obtained for patients in the diabetic group.

RESULTS

Most residents completed the worksheet, survey, and reflection (93%-98%, N = 42). The worksheets showed 70% of participants in the diabetic group had appointments scheduled after outreach, 42% were offered referrals to the Community Health Team, and 69% had overdue laboratory tests ordered. Residents reported they worked well with staff (95%), were successful in coordinating outreach (67%), and increased their sense of patient care ownership (66%). In reflections, identified successes were improved patient care, teamwork, and relationship with patients, while barriers included difficulty ensuring follow-up, competing patient priorities, and difficulty with patient engagement. Precurricular mean hemoglobin A1c was 7.7%, and postcurricular was 7.6% ( = .41).

CONCLUSIONS

The curriculum offered a feasible, longitudinal model to introduce residents to population health skills and interdisciplinary care coordination. Although mean hemoglobin A1c did not change, residents reported improved patient care. Identified barriers present opportunities for resident education in patient engagement.

摘要

背景

在内科住院医师医学教育中，小组管理被视为一项亚能力。尽管其很重要，但在内科住院医师培训项目中，关于人群医学的已发表课程却很少。

目的

我们探讨了一项为期5个月的糖尿病和肥胖门诊小组管理课程中住院医师的经历及临床结果。

方法

2016年8月至12月，佛蒙特大学医学中心的内科住院医师查阅了其糖尿病、糖尿病前期和肥胖患者的登记资料；完成学习模块；协调患者外展服务；并更新护理差距。使用描述性和主题性分析方法对住院医师的工作表、调查问卷和反思进行分析。获取糖尿病组患者糖化血红蛋白平均结果的前后数据。

结果

大多数住院医师完成了工作表、调查问卷和反思（93%-98%，N = 42）。工作表显示，糖尿病组70%的参与者在外展服务后安排了预约，42%的人被转介到社区健康团队，69%的人有逾期的实验室检查医嘱。住院医师报告称，他们与工作人员合作良好（95%），成功协调了外展服务（67%），并增强了对患者护理的主人翁意识（66%）。在反思中，确定的成功之处包括改善患者护理、团队合作以及与患者的关系，而障碍包括难以确保后续跟进、患者优先事项相互冲突以及患者参与度方面的困难。课程前糖化血红蛋白平均水平为7.7%，课程后为7.6%（P = 0.41）。